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House of Commons Fluoride Thyroid Cancer risk

House of Commons Fluoride Thyroid Cancer risk

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Published by: mary eng on May 18, 2013
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Standard Note:SN/SC/5689Last updated:5 March 2012 Author:Oliver BennettSection Science and EnvironmentThis notes sets out the positions of various groups regarding the effects of fluoridation of drinking water and
the Government’s position.
It is not a scientific critique.Information on legislation relating to fluoridation can be found in standard note SN/SC/3135
This information is provided to Members of Parliament in support of their parliamentary dutiesand is not intended to address the specific circumstances of any particular individual. It shouldnot be relied upon as being up to date; the law or policies may have changed since it was lastupdated; and it should not be relied upon as legal or professional advice or as a substitute for it. A suitably qualified professional should be consulted if specific advice or information isrequired.This information is provided subject toour general terms and conditions which are available online or may be provided on request in hard copy. Authors are available to discuss thecontent of this briefing with Members and their staff, but not with the general public.
1 The issue
Fluoridation of water is the process of artificially adjusting the natural fluoride content of drinking water in order to reduce the incidence of tooth decay. This is seen by some publichealth experts as an efficient way of tackling tooth decay in children and reducing healthinequalities.
 Fluoride is adjusted up to around 1.0mg/l, which is the recommended level of artificialfluoridation for drinking water to help prevent dental caries, particularly in children. Similar levels of fluoride are naturally found in drinking water in some areas of Britain.Fluoridation was first proposed in the late 1930s and introduced to North America in 1945. Itwas introduced to Britain as part of an experimental programme in 1955 before beingintroduced more widely in the 1960s.The safety and efficacy of fluoridation has been under almost constant review since it wasfirst proposed. Both pro and anti-fluoridation campaigners cite extensive and contradictoryscientific evidence and court judgements to support their arguments. It has been remarkedthat only smoking has been more extensively researched than fluoride.
 The EC drinking water directive (Directive 80/778/EEC) sets a level of 1.5mg/l for fluoride indrinking water. This is in line with the WHO guideline which represents a concentration which
“does not result in any significant risk to the health of the consumer over a lifet
ime of 
consumption”. The WHO guidelines however do caution that concentrations above this value
carry an increasing risk of dental fluorosis (cosmetic damage to tooth enamel), and much higher levels lead to skeletal fluorosis
(damage to the joints and bones and more serious damage toteeth).
 Fluoridation is seen, by those who support it, as a safe and effective means of reducinghealth inequalities and sparing many children the need to undergo teeth extraction with theassociated administration of anaesthetic.Those who oppose water fluoridation are concerned about the potential health impacts andthey have some ethical objections.
1.1 How widespread is fluoridation?
In the UK around 6 million people receive naturally and artificially fluoridated water:
In the UK, around half a million people receive naturally fluoridated water. A further 5.5million receive water which has been artificially fluoridated at, or around, the optimum
British Medical Association, Fluoridation of water, 12 January 2010, www.bma.org.uk
Meeting of the All-Party, Water group,
Fluoridation of Water Supplies
, 10 February 1998. Comment by Dr NoelOlsen, Chairman of the UK Public Health Medicine Consultative Committee for the British Medical Association.
Library Research Paper 93/121, p 10
level of one part per million (1ppm). West Midlands Strategic Health Authority (SHA)oversees the most extensive fluoridation scheme serving 84 per cent of its population.Smaller schemes are in place in the North East (34.8 per cent of population), EastMidlands (13.8), Eastern England (5.4), North West (3.8) and Yorkshire and Humber (2.6). In other parts of the UK, there are no artificial fluoridation schemes in operationand only rural Morayshire in Scotland receives naturally fluoridated water.
 A map showing average fluoride levels in water across England and Wales can be seenhere. Fluoridation is a controversial issue worldwide. Lobbying from green parties in other European countries has curtailed a number of water fluoridation schemes and some Member States, such as France and Germany, have opted to add fluoride to salt instead of water.
2 The York Review
In order to try and settle the debate about whether fluoride should be added to water, theLabour Government commissioned an independent expert review (the York review) in 1999on the safety and benefits of fluoridation. The Department of Health commissioned theCentre for Reviews and Dissemination at York University to carry out an expert scientificreview to assess the evidence on the efficacy and safety of population-wide drinking water fluoridation strategies to prevent caries. The review had four key objectives:
1. Assessment of the positive effects of fluoridation of public water supplies inpreventing caries (is a causal relationship likely?).2. If fluoridation is shown to have positive effects, what is the effect over and abovethat offered by the use of alternative interventions and strategies (i.e. fluoridatedtoothpaste, educational programmes, and increased self awareness of health issues?).3. Assessment of the negative health effects of fluoridation.4. Determination of whether fluoridation results in a reduction of caries across socialgroups and between geographical locations.
If the study confirmed that there were benefits to dental health from fluoridation and thatthere were no significant risks, the Government said it would introduce a legal obligation onwater companies to fluoridate where there was strong local support for doing so. The reviewdid not seek to examine issues such as the economic or the ethical implications of a massprogramme of fluoridation.The scientific review was led by Professor Jos Kleijnen, Director, National Health ServiceCentre for Reviews and Dissemination (CRD) at the University of York. An advisory groupoffering a range of expertise and perspectives was also appointed to oversee its scientificrigour and impartiality. This was chaired by Professor Trevor Sheldon, from the York HealthPolicy Group at University of York. The study employed a strict screening process to ensurethat the 214 studies finally included were suitably robust. For example, only primary studies(not reviews) were used and only test results from studies on humans.The commissioning of the review was generally welcomed by all involved in the debate. In
its response to the Government’s green paper on health, The National Pure Water 
British Medical Association, 
,viewed 12 January 2010
Fluoridation and dental health in Europe, information provided by the BFS on 18 March 1999

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